Giorgiutti S, Jamilloux Y, Gerfaud-Valentin M, Bert A, Ballonzoli L, Kodjikian L, Korganow A S, Poindron V, Sève P
Service d'Immunologie Clinique et Médecine Interne, CNR RESO, Maladies Auto-Immunes Et Systémiques Rares, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
INSERM UMR - S1109, Université de Strasbourg, Strasbourg, France.
Graefes Arch Clin Exp Ophthalmol. 2023 May;261(5):1391-1398. doi: 10.1007/s00417-022-05949-3. Epub 2022 Dec 24.
The study aims to describe the course and management of non-infectious uveitis during pregnancy and postpartum period in European populations.
A retrospective observational study in two tertiary centers in France was performed. Pregnant patients during the follow-up of a non-infectious uveitis as well as those with new-onset uveitis were included. The medical records were analyzed with a systematic collection of the characteristics of the uveitis, the treatment and evolution of the uveitis, and the course of the pregnancy including obstetric complications.
Seventy-nine pregnancies in 59 women were included: 48 patients (68 pregnancies) were followed for uveitis and 11 had a new-onset uveitis diagnosis. Most patients had idiopathic uveitis (32.2%) or sarcoid uveitis (27.1%). Among the patients followed for uveitis at the time of conception, there were 18 relapses (26.5%) requiring treatment escalation. Relapses occurred mainly in the two first trimester (n = 12) or during the postpartum period (n = 5) and were significantly associated with an active uveitis at the time of conception (OR = 9.2, 95% CI [1.57-48.4], p = 0.01). The characteristics of the new-onset uveitis were similar to those already existing before pregnancy. Obstetric complications occurred in 25 pregnancies (31.6%), mainly gestational hypertension and gestational diabetes.
The frequency of non-infectious uveitis relapses decreases as pregnancy progresses, in agreement with data from other non-European studies. However, multidisciplinary monitoring should be advised, especially to uncontrolled patients at the time of conception.
本研究旨在描述欧洲人群妊娠和产后期间非感染性葡萄膜炎的病程及管理。
在法国的两个三级中心进行了一项回顾性观察研究。纳入在非感染性葡萄膜炎随访期间的孕妇以及新发葡萄膜炎患者。对病历进行分析，系统收集葡萄膜炎的特征、葡萄膜炎的治疗及演变情况，以及包括产科并发症在内的妊娠过程。
纳入了59名女性的79次妊娠：48例患者（68次妊娠）因葡萄膜炎接受随访，11例被诊断为新发葡萄膜炎。大多数患者患有特发性葡萄膜炎（32.2%）或结节病性葡萄膜炎（27.1%）。在妊娠时因葡萄膜炎接受随访的患者中，有18例复发（26.5%），需要加强治疗。复发主要发生在孕早期前两个月（n = 12）或产后期间（n = 5），并且与妊娠时活动性葡萄膜炎显著相关（OR = 9.2，95%CI[1.57 - 48.4]，p = 0.01）。新发葡萄膜炎的特征与妊娠前已存在的葡萄膜炎相似。25次妊娠（31.6%）出现产科并发症，主要为妊娠期高血压和妊娠期糖尿病。
与其他非欧洲研究的数据一致，非感染性葡萄膜炎复发的频率随着妊娠进展而降低。然而，建议进行多学科监测，尤其是对妊娠时病情未得到控制的患者。
